PACKRAT 5 Exam Questions with Correct Answers

PACKRAT 5 Exam Questions with Correct Answers 6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx option for this pt? A. Desmopressin acetate B. Corticosteroids C. Vitamin K D. Cryoprecipitate - Answer-(u) A. Desmopressin acetate is indicated in von Willebrand's disease, which presents with a prolonged bleeding time. (u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia. (u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin K supplement is not indicated in this patient. (c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and function. Hemophilia A is treated with factor VIII concentrate or cryoprecipitate. HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain MRI reveals 6 lesions throughout the brain that show ring enhancement & surrounding edema. Which is the tx of choice? A. Sulfadiazine and pyrimethamine B. Trimethoprim-sulfamethoxazole C. Radiation therapy D. Ventricular shunt placement - Answer-(c) A. Toxoplasmosis is commonly noted in HIV positive patients and presents with multiple ring-enhancing lesions. Treatment of choice for possible toxoplasmosis is sulfadiazine and pyrimethamine. (u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of toxoplasmosis, but not for treatment of acute infection. (u) C. Radiation therapy is indicated in CNS lymphoma, which typically presents with a single lesion. (u) D. Shunt placement is not indicated in patients with toxoplasmosis. On examination of a pregnant patient the physician assistant notes a bluish or purplish discoloration of the vagina and cervix. This is called A. Hegar's sign. B. McDonald's sign. C. Cullen's sign D. Chadwick's sign - Answer-(u) A. Hegar's sign is the softening of the cervix that often occurs with pregnancy. (u) B. McDonald's sign is when the uterus becomes flexible at the uterocervical junction at 7-8 weeks. (u) C. Cullen's sign is a purplish discoloration periumbilical and noted in pancreatitis. (c) D. Chadwick's sign is a bluish or purplish discoloration of the vagina and cervix.